Before coding 20660, check that the cranial tongs, caliper, or stereotactic frame application qualifies as a separate procedure. The just released CPT® Assistant provides examples of correct 20660 usage.
You may report 20660 for example, “when the device application is not performed solely for intraoperative positioning,” states “Coding Brief: Cranial Tong Application (Code 20660)” (CPT® Assistant, April 2012, page 11). Code 20660 is also appropriate when “the halo device is applied by another physician (who is neither in the same group practice nor participates in the planned open surgical fracture treatment occurring several days later).”
Check your coding accuracy by trying your hand at the following coding example from CPT® Assistant.
Diagnosis: C5-6 perched or locked facets and retropulsed C6 burst fracture.
Day 1: Gardner-Wells tongs placed, tightened, traction placed, additional traction placed, improved alignment significantly.
Day 2: Corpectomy, discectomy, fusion, instrumentation, and allograft (same physician).
On day one, report the appropriate level evaluation and management service code appended with modifier 57 (Decision for Surgery). “Code 20660 is also reported for application of the Gardner-Wells tongs to stabilize and align the spine pending definitive surgical fracture treatment,” according to CPT® Assistant.
On day two for the surgical fracture repair, report the appropriate corpectomy, discectomy, fusion, and instrumentation codes. The Medicare Physician Fee Schedule assigns 0 days to 20660. Therefore, Medicare does not require you to append the intervention code with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period). CPT® Assistant, however, indicates you may need to append day 2’s intervention code(s) with modifier 58 “based on payer assignment of postoperative days for code 20660.”
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